News Scan for Jul 23, 2018

News brief

PAHO identifies Venezuela, Brazil as measles hot spots

In its latest epidemiologic update, the Pan American Health Organization (PAHO) reported late last week that 2,472 cases of measles had been confirmed in 11 countries in the Americas in 2018. PAHO said Venezuela and Brazil recorded the most activity, with more than 2,200 confirmed cases between them.

Most countries have only a handful of cases, including Antigua and Barbuda (1 case), Argentina (5 cases), Ecuador (17), Guatemala (1), Mexico (5), and Peru (3). Canada has 19 cases, and Colombia and the United States have had 40 and 91 cases, respectively.

Authorities in Brazil have tracked 677 cases in six states since January, with almost two thirds (65.6%) of the outbreak in Amazonas state. Almost all cases in Amazonas are genetically identical to those found in the Venezuelan outbreak.

PAHO said the outbreak in Amazonas is expected to grow, as up to 80% of suspected cases have not yet been tested. Children ages 0 to 4 years make up most cases.

Venezuela has recorded 1,613 cases this year in an outbreak that's been ongoing since 2017. PAHO also noted at least 44 deaths possibly attributed to measles in Venezuela, and said the region's indigenous population is particularly vulnerable to measles.
Jul 20 PAHO update


Rotavirus vaccines tied to less acute gastroenteritis in high-risk infants

Rotavirus vaccines, introduced between 2006 and 2008, have led to substantially reduced acute gastroenteritis (AGE) and rotavirus hospitalizations in the youngest high-risk children, similar to reductions seen with normal-birth-weight children, according to a study based on 14-year study of insurance claims data.

Researchers from the US Centers for Disease Control and Prevention (CDC) reported their findings in the August issue of The Pediatric Infectious Disease Journal.

Using inpatient hospital claims from July 2001 to June 2015, the investigators looked at AGE and rotavirus hospitalizations for low-birth-weight (LVW), very-low-birth-weight (VLBW), and normal-birth-weight (NBW) children younger than 5 years old, focusing on levels before the vaccine was introduced (2001 to 2006) and after rotavirus vaccination began (2007 to 2015).

Vaccination coverage as of December 2014 was 87%, 82%, and 64% for NBW, LBW, and VLBW infants, respectively. For 2014 to 2015 among children younger than 5, AGE hospitalization rate reduction compared with the prevaccine period were 60%, 64%, and 55% for the groups, respectively. For rotavirus hospitalizations, reductions were 91%, 98%, and 93%, respectively.

Comparing unvaccinated and vaccinated NBW, LBW, and VLBW children ages 3 to 23 months, vaccines reduced AGE hospitalization by 62%, 72%, and 71%, respectively.

The team concluded that the study shows the substantial impact rotavirus vaccines have had on reducing rates of AGE and rotavirus hospitalizations in US kinds under 5 and provides the first evidence of the impacts on LBW and VLBW kids, which couldn't be assessed in prelicensure trials because of small sample sizes. "Efforts to improve vaccination coverage, particularly in LBW and VLBW infants, should continue," they wrote.
August Pediatr Infect Dis J abstract

Stewardship / Resistance Scan for Jul 23, 2018

News brief

Study: Intervention improves intraoperative antibiotic redosing

A multipronged project to improve intraoperative antibiotic redosing led to dramatic and sustained improvements in antibiotic redosing rates at an Iowa hospital, according to a new study in the American Journal of Infection Control.

The quality improvement project at University of Iowa Hospitals and Clinics began in 2015 with the introduction of a guideline-based intraoperative Antibiotic Administration Guide that listed recommendations for antibiotic choice by surgical category on one side and redosing recommendations on the other. The guide was distributed to anesthesia providers, and multiple education sessions were held for anesthesia providers, surgeons, nurses, and pharmacists who work regularly in the operating room. In addition, an automated redosing reminder was included in anesthesia electronic health records (EHRs). The department of anesthesia reported antibiotic redosing rates monthly to hospital leadership to encourage peer accountability and feedback.

In the retrospective observational study, a total of 13,695 surgical procedures performed from 2013 through 2017 were assessed using an interrupted time-series model. The compliance rate with intraoperative antibiotic redosing criteria for all surgeries lasting more than 4 hours was the primary outcome. Although the interrupted time-series model showed there was an already improving trend prior to the multifaceted intervention (incidence rate ratio [IRR], 1.004 per week), a 15% increase in appropriate antibiotic redosing rates (IRR, 1.158) was observed at the end of the intervention, with no compromise in the baseline improvement trend.

"Our experience demonstrates that combining EHR-based interventions with education and incentive models may help further improve compliance rates," the authors of the study conclude. They note that further studies to determine whether the intervention had an effect on clinically meaningful outcomes, such as surgical-site infections, are ongoing.
Jul 20 Am J Infect Control study


Antibiotic-resistant E coli increasing in Swiss nursing homes

An analysis of 10 years of resistance data from nursing homes in Switzerland found increasing levels of extended-spectrum cephalosporin-resistant (ESC-R) Escherichia coli, but with declining levels of methicillin-resistant Staphylococcus aureus (MRSA).

The study covers data from isolates sent to the Swiss Centre for Antibiotic Resistance from January 2007 to October 2017. Researchers from Switzerland published their findings in a Jul 20 online edition of Antimicrobial Resistance and Infection Control.

To explore carbapenem-resistance patterns in nursing homes among gram-negative bacteria, which included ESC-R E coli and Klebsiella pneumonia, MRSA, and glycopeptide-resistant enterococci (GRE), the group looked at 16,804 samples from 9,040 patients, mostly from urinary sources. Most patients were from the French/Italian speaking part of Switzerland in the west and south.

ESC-R E coli increased from 5% in 2007 to 22% in 2017, while MRSA levels declined from 34% to 26% over the same period. Nitrofurantoin and fosfomysin retained high susceptibility rates against E coli, even for ESC-R isolates.

The researchers said a significant increase of ESC-R among E coli and K pneumonia mirrors an increase seen in the antibiotic resistance database for hospitals and outpatient clinics. The team also noted that the proportion of MRSA among S aureus isolates is also declining in hospitals.

The authors said the generalizability of their data is hampered by overrepresentation of the French/Italian speaking part of the country, but the prevalence of ESC-R E coli and K pneumonia among Swiss nursing homes has clearly been rising over the past decade. Also, they noted that more efforts should be taken to increase the number of nursing home samples from German-speaking parts of Switzerland to the resistance database.
Jul 20 Antimicrob Resist Infect Control abstract


PAHPA reauthorization moves forward, without new antibiotic incentive

A reauthorization of a pandemic preparedness bill approved last week by the US House Energy and Commerce Committee will not include an incentive aimed at spurring development of new antibiotics.

According to reporting by Stat, proponents of the incentive, the language of which was originally included in a bill titled the Re-Valuing Anti-microbial Products (REVAMP) Act of 2018, had hoped to have it inserted as an amendment to the reauthorization of the Pandemic and All-Hazards Preparedness Act (PAHPA), but that effort stalled. PAHPA, originally passed in 2006, now heads for a vote in the full US House of Representatives.

The proposed incentive would award drug companies that develop a priority antimicrobial product an extra 12 months of market exclusivity that could be used for another drug product. Companies could also extend market exclusivity for several drugs for less than a year. In return, drug makers would have to track resistance data, develop guidelines and procedures for appropriate use, and assess stewardship of the new antibiotic.

Backers of the idea view it as an important "pull" incentive that could spur antibiotic development. But as Stat reports, a coalition of physicians, hospitals, insurers, and pharmacy benefit managers, concerned that the incentive would delay patient access to cheaper generic drugs, urged Congress not to include the proposal in the PAHPA reauthorization.
Jul 18 Stat story
Jun 29 CIDRAP News story "Bipartisan bill proposes new 'pull' incentives for priority antibiotics"



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